Behavioral adjustment to avian flu in Europe during spring 2006: The roles of knowledge and proximity to risk Caroline Rudisill a, b, * , Joan Costa-Font a, b, c , Elias Mossialos a, b a LSE Health, London School of Economics and Political Science, London, UK b Department of Social Policy, London School of Economics and Political Science, London, UK c European Institute, London School of Economics and Political Science, London, UK article info Article history: Available online 2 July 2012 Keywords: European Union Avian flu Public health Global health threats Knowledge Proximity of risks Health behavior abstract The threat of a widespread avian flu influenza outbreak represented a significant public health challenge for the European region during late 2005 and early 2006. Little is known, however, about how indi- viduals learn about new global-level health risks, especially influenza outbreaks. We empirically test the hypothesis that knowledge about and geographic proximity to avian flu play a role in individuals’ consumption behavior regarding this health risk. This article employs Eurobarometer survey data collected in spring 2006 to examine how Europeans (from 27 European Union countries plus Croatia and Turkey) altered their consumption of poultry, eggs and egg-based products during the virus’ emergence in Europe. Our findings are consistent with the hypothesis that behavioral change indeed depends on proximity to those risks. Significant differences emerged between individuals’ likelihood of behavioral change in countries where avian flu had been found in humans either in individuals’ countries of resi- dence or in bordering countries. Furthermore, we find that those who were more knowledgeable about avian flu risks were less likely to have reduced their consumption of poultry, eggs or egg-related products in the spring of 2006 compared to six months prior. Yet, the influence knowledge has on consumption behavior is found to change depending on proximity to avian flu risks. These findings have implications for our larger understanding of how individuals alter their behavior in the face of new health risks. Ó 2012 Elsevier Ltd. All rights reserved. Introduction In developing policy solutions to aid in the response to health- related risks, a key aim lies in encouraging informed decision- making. As discussed in some examples in Brocas and Carrillo (2009), more information does not necessarily lead to more rational or predictable decision-making because of biases, experi- ences and beliefs influencing the way individuals update their preference structures and make decisions. The emergence of the avian influenza (H5N1) virus in the Euro- pean region in late 2005 and early 2006 allows us to examine how individuals reacted in the face of a risk about which they were processing new information almost simultaneously with being confronted with that risk. H5N1 presents a challenging scenario for public health communication because while the virus has exhibited transmission between animals and between humans and animals, it could potentially mutate into a new virus subtype with widespread human to human transmission. Given the epidemiological state of H5N1 during late 2005 and early 2006, the prevailing public health advice was that environmental factors and insufficient cooking of infected poultry would increase one’s likelihood of contracting the virus but eating cooked poultry and related products would not (WHO, 2007). This paper uses a Eurobarometer survey conducted in spring 2006 to assess whether knowledge about avian flu and geographic proximity to avian flu cases play a role in the likelihood of Europeans altering their consumption of poultry, eggs and egg- related products as H5N1 cases in the region emerged. Reactions to avian influenza-related risks include limiting poultry consumption because of fears related to eating food possibly infected by the virus. Apart from restricted dietary choice, a reduction in poultry consumption has cost implications for poultry exporting nations and regions. Losses come not only from culling infected poultry stocks but also reduced poultry demand. The motivations for risk communication during a food-related crisis differ depending on the nature of the crisis. During contamination-related food recalls, information dissemination about food safety would be aimed at decreasing the consumption of unsafe food. For avian influenza, information about associated consumption risks targeted consumers’ understandings that * Corresponding author. LSE Health, Cowdray House, London School of Economics, Houghton Street, London WC2 2AE, UK. E-mail addresses: a.c.rudisill@lse.ac.uk (C. Rudisill), j.costa-font@lse.ac.uk (J. Costa-Font), e.a.mossialos@lse.ac.uk (E. Mossialos). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.socscimed.2012.06.005 Social Science & Medicine 75 (2012) 1362e1371